Bursae, are small, jelly-like sacs that are located throughout the body, including
around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid,
and are positioned between bones and soft tissues, acting as cushions to help reduce
friction.

Bursitis is inflammation of the bursa. There are two major bursae in the hip that
typically become irritated and inflamed. One bursa covers the bony point of the hip
bone called the greater trochanter. Inflammation of this bursa is called trochanteric
bursitis.

Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the
hip. When this bursa becomes inflamed, the condition is also sometimes referred to
as hip bursitis, but the pain is located in the groin area. This condition is not
as common as trochanteric bursitis, but is treated in a similar manner.

Hip bursitis most often involves the bursa that covers the greater trochanter of the
femur, although the iliopsoas bursa can also become inflamed.

Reproduced with permission from The Body Almanac. (c) American Academy of Orthopaedic
Surgeons, 2003.

Symptoms

The main symptom of trochanteric bursitis is pain at the point of the hip. The pain
usually extends to the outside of the thigh area. In the early stages, the pain is
usually described as sharp and intense. Later, the pain may become more of an ache
and spread across a larger area of the hip.

Typically, the pain is worse at night, when lying on the affected hip, and when getting
up from a chair after being seated for a while. It also may get worse with prolonged
walking, stair climbing, or squatting.

To diagnose hip bursitis, the doctor will perform a comprehensive physical examination,
looking for tenderness in the area of the point of the hip. He or she may also perform
additional tests to rule out other possible injuries or conditions. These tests can
include imaging studies, such as x-rays, bone scanning, and magnetic resonance imaging
(MRI).

Nonsurgical Treatment

The initial treatment for hip bursitis does not involve surgery. Many people with
hip bursitis can experience relief with simple lifestyle changes, including:

Activity modification. Avoid the activities that worsen symptoms.

Non-steroidal anti-inflammatory drugs (NSAIDs). Ibuprofen, naproxen, piroxicam, celecoxib,
and others, may relieve pain and control inflammation.Use NSAIDs cautiously and for
limited periods. Talk with your doctor about the NSAIDs you use. NSAIDs may have adverse
side effects if you have certain medical conditions or take certain medications.

Assistive devices. Use of a walking cane or crutches for a week or more when needed.

Physical therapy. Your doctor may prescribe exercises to increase hip strength and flexibility. You
may do these exercises on your own, or a physical therapist may teach you how to stretch
your hip muscles and use other treatments such as rolling therapy (massage), ice,
heat, or ultrasound.

Steroid injection. Injection of a corticosteroid along with a local anesthetic may also be helpful in
relieving symptoms of hip bursitis. This is a simple and effective treatment that
can be done in the doctor's office. It involves a single injection into the bursa.
The injection may provide temporary (months) or permanent relief. If pain and inflammation
return, another injection or two, given a few months apart, may be needed. It is
important to limit the number of injections, as prolonged corticosteroid injections
may damage the surrounding tissues.

Surgical Treatment

Surgery is rarely needed for hip bursitis. If the bursa remains inflamed and painful
after all nonsurgical treatments have been tried, your doctor may recommend surgical
removal of the bursa. Removal of the bursa does not hurt the hip, and the hip can
function normally without it.

A newer technique that is gaining popularity is arthroscopic removal of the bursa.
In this technique, the bursa is removed through a small (1/4-inch) incision over the
hip. A small camera, or arthroscope, is placed in a second incision so the doctor
can guide miniature surgical instruments and cut out the bursa. This surgery is less
invasive, and recovery is quicker and less painful.

Both types of surgeries are done on an outpatient (same-day) basis, so an overnight
stay in the hospital is not usually necessary. Early studies show arthroscopic removal
of the bursa to be quite effective, but this is still being studied.

Following surgery, a short rehabilitation period can be expected. Most patients find
that using a cane or crutches for a couple of days is helpful. It is reasonable to
be up and walking around the evening after surgery. The soreness from surgery usually
goes away after a few days.

AAOS does not endorse any treatments, procedures, products, or physicians referenced
herein. This information is provided as an educational service and is not intended
to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon, or locate one in your area through
the AAOS "Find an Orthopaedist" program on this website.